The Secret to Our Future: Leadership

The Secret to Our Future

Leadership

Daniel A. Hammer, DDS, FACD

Abstract The pandemic caught all by surprise. Some like dentistry have recovered quickly; others are facing increasingly severe echoes. The prognosticators about the “new normal” are rehearsing the customary challenges of technology, delivery models, and student debt and are generally moving only so far as compiling a list questions to prove how serious they are. The one constant is that the only healthy future is one that will have leaders showing the way.

Dr. Hammer is director of Research, Oral, Head and Neck Oncology and Maxillofacial Reconstructive Microsurgery and Director, Microvascular Surgery Training, Naval Medical Center San Diego; danielhammeroms@gmail.com. He was the Regent Intern of the college from 2015–2016. What will oral health and dentistry look like in 20 years? As I write this, the number of Covid19 cases is rising throughout the country and the “third peak” is present in numerous regions throughout the United States and the world. As we all adjust to this continuously changing situation, to predict what dentistry may look like in six months, let alone 20 years, is extremely challenging. There is so much to be learned about the virus, its transmission, and overall behavior that regulators and practitioners alike cannot speak with absolute confidence regarding safety protocols or patient care delivery models. However, to date, there has not been any outbreak attributed to a dental office, and the infection rate among dentists is less than one percent. Dentistry has done an incredible job adapting to this everchanging landscape and continuing to provide safe care to our patients.

The pandemic has undoubtedly changed everything. We will shape the future course of our profession by how we collectively evaluate and respond to the current threats and opportunities presented by the Covid-19 pandemic. The answers to our most pressing questions will not be solved by a single stakeholder or interest group. It will require extensive collaboration in order to foresee second and third order effects and to successfully navigate the emerging challenges.

The optimism I have for the continued adaptability and success of our profession is grounded in the fact that this is not the first time we have been confronted by a pandemic of unknown severity or duration. In the 1980s, the HIV epidemic was at the forefront and dentistry responded with a concerted effort to ensure safety for both healthcare teams and patients. The emergence of HIV led to significant changes to all healthcare practices with the implementation of universal precautions, which are now standard operating procedure for all fields in dentistry and medicine. Adherence to these guidelines is the most effective way to protect ourselves and the patients we serve. These regulations took time to develop and their implementation in everyday practice was slow and deliberate, and we can predict similar changes in the post-Covid era regarding aerosolizing procedures.

In order to determine the most critical challenges and largest opportunities for our profession, we need to look at dentistry’s current state. According to the Economic Impact on Dental Practices Report released from the American Dental Association on October 19, 2020, our profession has made significant progress since the onset of the pandemic.1 The report is the result of more than 13,000 dentists reporting the current trends within their practices. Nearly all (98.7%) of dental practices surveyed were open, although 59.3% of practices noted limited hours compared to prior to the pandemic. In addition a large number (64.2%) of dentists reported they are

seeing greater than 75% of their pre-Covid patient volume.

Many of our patients have shown a renewed confidence in obtaining care during the ongoing pandemic. According to a survey completed by the Back to Normal Barometer, which surveyed dental patients throughout the country, 79% of patients had already been seen by a dentist or would be comfortable scheduling an appointment for dental care.1 The remaining 21% stated they would either need a medical breakthrough in order to schedule an appointment (14%) or need assurance from an outside source that it was safe to return to dental care (7%).

The “New Normal” and Its Questions With practices opening and patients returning to regular care, we now have the ability to start predicting the stakeholders and influences that will determine where our profession might be in 20 years. The goal of the remainder of this manuscript is to discuss these influences and how they may shape our near future.

Without question, the post-Covid era will be full of new regulation on the federal and state levels for all healthcare practices. This is especially true for those who have been deemed “essential” in order to be wellprepared for our next pandemic. We will await new OSHA and CDC guidelines on professions that provide aerosolizing procedures once Covid19 and similar pathogens are further studied. These regulations will have economic and legal effects that will modify patient care standards. How will the additional regulations change the cost to provide dental care? How are these increased costs offset and how will we integrate the new regulations into our practices? Last, how will state dental boards regulate and ensure proper reporting and compliance with the new standards?

The pandemic changed delivery models in all healthcare professions. The pandemic accelerated the adaptation of teledentistry, while online retail of dental products and home remedies skyrocketed. In addition, differing models of healthcare delivery such as dental service organizations (DSOs), small group practice, and solo practitioners each experienced the impact of the pandemic differently. It is likely that the healthcare delivery model in dentistry has been forever changed by the pandemic. Will dentists deliver vaccines in the future? Will teledentistry continue to grow and become a permanent fixture in patient care? What is the standard of care for teledentistry and what can be completed for patient care in this remote setting? Will the constraints of the pandemic ultimately help or hurt the wide variety of differing practice models?

In addition to our delivery models, our workforce has dramatically changed in the wake of the pandemic. If we continue to reflect and work together, as a united profession, to answer these tough questions, we will enter the post-Covid era stronger than before.

All team members with school-aged children have had to balance continued professional obligations with homeschooling and lack of reliable childcare. In addition, it has become increasingly difficult to recruit and retain both dental assistants and dental hygienists due to their concern for their safety in the office. Many dentists experienced demands from staff regarding safety and pay increases. According to the ADA, one-third of dentists are recruiting dental assistants and onequarter are recruiting dental hygienists to their practices. However, 80% of dentists report it is “extremely” or “very challenging” to recruit dental assistants and dental hygienist to their practices.1 How can dentistry ensure the safety of our teams in order to have a workforce ready to care for those in need? What happens if our supporting staff decides not to return to work in the dental office?

An influence that was present well before the pandemic and now has considerably more impact on the profession is the notion that dental care is a commodity. Consumerism has placed dental care in the same category as other discretionary income purchases for an individual. In a time when countless individuals have lost their jobs and federal program funding is inconsistent, the resources needed for patients to obtain dental care are unreliable. How can we best support these patients? How can we incentivize practitioners to care for this vulnerable population?

According to the American Dental Education Association, the average dental student graduates with $292,169 in debt. In addition, this debt is associated with high interest rates that are updated annually by the government and can be as high as 10.5%. Almost all loans are not subsidized, and income-based repayment and the Public Service Loan Forgiveness Program are always open to changes and cannot be counted on. Dental school tuition has only increased, and scholarships and other merit-based financial aid is fleeting. This debt burden does not include the additional expense from seeking specialty training. Additionally very few are able to refinance their loans due to the concern of having a fixed payment in an environment with variable net income. The enormous debt early-career dentists have is directly influencing their professional choices (type of practice, location) and personal choices (home ownership, starting a family) among others. How can we advocate and support our new dental colleagues? How will this debt burden and its influence on our personal and professional decisions form the future landscape of our profession?

We cannot live without technology. It has infiltrated all aspects of our daily life and its influence is only accelerating. Technology has advanced our procedural techniques and has led to improving patient outcomes, increasing efficiency and, in some cases, lowered cost. This combination directly speaks to the value proposition that has recently driven our healthcare economic decision making and that is to improve outcomes while lowering cost. In addition, technology has opened up new channels for communication, collaboration, and information sharing. How will dentistry be impacted by the rapid advances in technology? Leaders Will Get to the Future before the Rest

The most nimble professions are those that are organized and value leadership. Although the patient is the end user of the healthcare system, decisions are made at the organizational level (government, industry, professional associations, etc.) that directly dictate our daily clinical practice. Similar to the HIV epidemic, Covid has challenged our profession to think bigger and take direct action in an attempt to ensure the long-term success of our profession and the health of the patients. Our professional associations have shown adaptive and agile leadership. If we continue to reflect and work together, as a united profession, to answer these tough questions, we will enter the postCovid era stronger than before. If we do not work together to advance the profession, other influences discussed prior will write the rules of the post-Covid era for us. n

Online Source 1 American Dental Association COVID-19 Report:

Economic Impact on Dental Practices Week of

October 19 Results. https://surveys.ada.org/ reports/RC/public/YWRhc3VydmV5cy01ZjhmNTg0M

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